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Treat kid’s sleep problems with interdisciplinary approach

Filed in
  • Snoring
  • Pediatrics
  • children
  • Insomnia
  • Sleep apnea

By Lynn Celmer  |  Dec 07, 2012
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Pediatricians and respiratory specialists should work together whenever a sleep problem is suspected in a child, a new study reports. Children with sleep-related breathing problems such as snoring or apnea frequently have behavioral sleep problems such as waking repeatedly. Children with sleep disorders often aren’t evaluated and treated for behavioral sleep problems - and vice versa.

"Our findings should raise awareness among parents and physicians that if a child is sleeping poorly, they should delve deeper to see if there is an unrecognized respiratory-related sleep problem," said senior author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Albert Einstein College of Medicine of Yeshiva University. "The best way to make sure this happens is by taking an interdisciplinary approach to the care of these children."

The study was published in the December 4, 2012 online edition of the journal Behavioral Sleep Medicine. The researchers analyzed data on more than 11,000 children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

In response to mailed questionnaires, parents reported their child's snoring and apnea at 18, 30, 42, and 57 months of age. For the same time intervals, parents were also asked whether their child refused to go to bed, and whether they regularly woke early, had difficulty sleeping, had nightmares, got up after being put to bed, woke in the night or awakened after a few hours. Children with five or more of these behaviors simultaneously were considered to have a clinically significant behavioral sleep problem.

The prevalence of behavioral sleep problems over the 18-to 57-month age reporting period ranged from 15 to 27 percent with a peak at 30 months of age. Among children with behavioral sleep problems, 26 to 40 percent had habitual SDB, again peaking at 30 months. Among children who had habitual SDB, 25 to 37 percent also had a behavioral sleep problem, peaking at 30 months.

While it is unlikely that behavioral sleep problems cause sleep disordered breathing, the converse may be true, noted Dr. Bonuck. Frequent night wakings initially related to sleep disordered breathing may be reinforced by the parents' anxious responses. These behaviors may, in turn, develop into a persistent behavioral sleep problem, despite adequate treatment for sleep disordered breathing.

"It's important that we pay attention to how our children are sleeping," said Dr. Bonuck. "There's ample evidence that anything that interrupts sleep can negatively affect a child's emotional, cognitive, behavioral and academic development. Fortunately, snoring and apnea are highly treatable, and there are many effective interventions for behavioral sleep problems."

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